Emergence of the M Phenotype of Erythromycin-Resistant Pneumococci in South Africa

• Main Authors: Carol A. Widdowson, Keith P. Klugman
• Format: Article
• Language: English
• Published: Centers for Disease Control and Prevention 1998-06-01
• Series: Emerging Infectious Diseases
• Subjects: United States; South Africa
• Online Access: https://wwwnc.cdc.gov/eid/article/4/2/98-0216_article

Erythromycin-resistant pneumococci have been isolated in South Africa since 1978; however, from 1987 to 1996, resistance to macrolides was only detected in 270 (2.7%) of 9,868 blood or cerebrospinal fluid (CSF) pneumococcal isolates, most of which were obtained from the public sector. In South Africa, macrolide use in the public sector is estimated at 56% of that in the private sector. Most erythromycin-resistant strains (89%) exhibited resistance to erythromycin and clindamycin (macrolide-lincosamide-streptogramin B phenotype). In the United States, most erythromycin-resistant pneumococci exhibit the newly described M phenotype (resistance to erythromycin alone), associated with the mefE gene. The M phenotype in South Africa increased significantly in the last 10 years, from 1 of 5,115 to 28 of 4,735 of blood and CSF isolates received from 1987 to 1991 compared with 1992 to 1996 (p = 5x10-7). These data suggest that, although macrolide resistance in pneumococci remains low in the public sector, the mefE gene is rapidly emerging in South Africa.